After a three-year stint at Winnipeg’s Deer Lodge Centre as a case manager for people who had suffered severe traumatic brain injuries, Brenda Rust developed a passion for that line of work, and decided to become a Speech Language Pathologist. For the last several years, she has practiced privately in Brandon, and is particularly excited to be involved in a new charitable organization, Westman Aphasia Inc., which offers help to brain-injured people attempting to cope with loss of communication skills. (BRUCE BUMSTEAD/BRANDON SUN)
You and I met almost three years ago when I was having some tremendous problems with my voice. As a journalist, a teacher, a voice-over artist, and a singer, I was terrified! You helped me find a path to near-full recovery, for which I’ll always be grateful.
Well, I’m glad I could help. But my main area of focus is traumatic brain injury and stroke. And I do just a little bit of voice. I’m not an expert in the area of voice — that’s why I sometimes refer people like you to the Voice Clinic at Health Sciences Centre in Winnipeg, and then consult with the experts there.
They certainly helped me a lot in Winnipeg. But it was a great comfort to know you were here for me. And I haven’t told you this — once I was in singing shape again — and it took more than a year — I performed a concert, after which a woman came up and said she’d heard about my voice problems and asked how I’d managed to overcome them. She was almost croaking! I felt so badly for her. My voice is not completely where it was, but I’ve gotten back probably about 90 per cent of what I had. Do things like the voice, our speaking voices, degenerate as we get older?
Our bodies change over time, so we lose the elasticity, and our muscles change — they weaken — as we age. But we all age differently. Some people who have voice problems are often a little more vulnerable that way, just because of the way they’re put together.
But sometimes it’s a combination of the perfect storm of factors. You might have someone who’s dealing with a lot of stress — maybe some health issues that cause them to worry, and they’re concerned about the future, so you have the stress factors there. Maybe they’re people who use their voices a lot, too — people who like to talk a lot, sing in the church choir.
People who are aging, who have psycho-emotional factors going on, as well as over-use issues — maybe they’re using their voices too much for what the musculature can handle. And as we get older, sometimes it’s not a matter of fixing the voice, or recovering the voice, it’s a matter of managing the factors that are affecting the voice.
So for some people, the voice never does return to normal as they age. But it’s making sure it’s as healthy as it can be as they get older, so they can still continue to communicate.
Many of us are not aware we’re doing things that might be detrimental to our voices, until after the fact — you go to the hockey game and you’re yelling your lungs out for the home team, and there’s loud music, and you’re talking over crowds. But most of us DO feel or notice the effects the next day. I suppose it differs from person to person, but are we doing real damage?
We talk about overuse injuries. It’s just like any other part of the body. Some of us are going to have knee issues, some are going to have hip issues, some of us back issues. We all deal with stress differently. Some people, it hits the head and they get headaches. You can wind up with gastrointestinal problems — stomach problems. So there’s a stress factor there — you have to have an environment of some kind of stress typically for some kind of voice disorder to develop. So if your voice tells on you — if that’s where you’re hit with stress — you might hold it there.
Going back to overuse — maybe you’re going off to a job where you’re using your voice a lot — a teacher, for example — so then you’re not allowing that voice to recover. We all overuse our voices and need to allow that recovery time. But there are a number of factors that continue to develop over time and it contributes to the development of a voice disorder.
Once you have a voice disorder, things can just compound continually, and then it’s hard to get it back to where it once was, right?
It’s a problem when you start to have hoarseness that’s lasting for prolonged periods of time, or even aphonia — complete loss of voice. Some people who sing will lose their pitch range. And if you’re really unlucky, you’ll wind up with some changes to the vocal cords — men tend to get polyps, women tend to get vocal nodules. Sometimes it’s just thickening of the vocal cords, which can result in prolonged hoarseness, but if you have nodules developing, that’s when you actually start to have pitch breaks and loss of your range.
We’re just nicely back into the school year, and teachers particularly run into vocal trouble — not as much talking, or at least projecting, in the summer months, and then it’s back into the classroom and needing to talk a whole lot more, and usually a whole lot more loudly. Any advice for those folks?
More and more teachers are winding up with voice disorders, because there are more and more demands and there’s more stress in our lives. So seek professional help — see a speech pathologist — and also use voice amplifiers. In the classroom environment, they can really help to preserve the voice so it’s not being over-used and abused. And the school divisions need to be very supportive of that, because it’s a matter of keeping teachers in the classroom — or not.
You work as a private practitioner. And I’m not trying to slag the medical system. But when I came to you, I had lost much of my speaking voice and several notes were just gone from my singing range. But when I looked into getting assistance, I was absolutely horrified — because I thought this was covered by Manitoba Health — to find that if I wanted to get help at the hospital, it was going to be a three- or four-year wait! I understand that if we can’t get trained practitioners, we can’t help people, but that situation seemed unbelievable to me!
It’s just the way things are right now here locally. From what I understand, the services are mostly for inpatients. So if you’re acutely ill and need a speech pathologist, they’re there for you. It’s when you’re discharged — the outpatient services — they just don’t have the staffing right now. And it’s really difficult to recruit speech pathologists and keep them here because they’re so much in demand. Not everybody is trained to work with adults. The majority of speech pathologists like working with the pediatric population. And speech pathologists are predominantly female, so that means that when you recruit someone locally, you have to make sure that their husband is going to have a job, too. So I think it’s just a combination of factors.
You specialize in communication issues for those who have undergone severe brain injuries. So you would see people who had suffered accidents, and strokes, and …?
Degenerative neural — like Parkinson’s, ALS, Multiple Sclerosis, the different types of Muscular Dystrophies — things like that. We follow people from birth to death, and often I wind up working with people who are in later stages of life where they’re getting closer to their death, and that’s a very important time to be able to communicate. There still is that need. So I’m really thrilled to be part of Westman Aphasia Inc.
Once people are discharged from hospital and go home, typically after a stroke — these are people who have moderate or severe aphasia, which is an impaired ability to communicate — their ability to read, to understand what’s said to them, their ability to speak, their ability to write — are affected. So people often become socially isolated, and their caregivers become burned out. And there’s nothing in our health-care system to help these folks — these are people who are affected for life. It’s a chronic impairment.
Westman Aphasia Inc. is modelled after the Aphasia Institute in Toronto — they have a wonderful program there for these people. And we’re the only organization in Western Canada that’s doing this. There’s a social worker and a core of volunteers — we have a really active, excellent board. So we’re up and going now — we got funding from the United Way and we just need to recruit people from the community who have this condition. For twelve sessions over a 10-week course, it’s $100 for a couple — just enough to cover our expenses. It’s an excellent program and I’m really excited about it and that’s where I focus a lot of my other time outside of private practice.
I think a lot of people think that speech pathologists "fix" things. And in pediatrics, perhaps they can. But in your field, working with people who have neurological damage, that’s not usually possible, is it?
No. People think that I’m going to fix voices, and I don’t. Often it’s not fixing — it’s learning to do something a different way to compensate for a loss, and to manage their skills so that they can function to the best of their ability.
For more information about Westman Aphasia Inc., go to westmanaphasia.ca or call 204-571-0802.
Republished from the Brandon Sun print edition September 8, 2012